Hypertrophic Pyloric Stenosis Protocol: A Single Center Study

Creators

Nelimar Cruz-Centeno, Children's Mercy Kansas CityFollow
James A. Fraser MD, Children's Mercy HospitalFollow
Shai Stewart MD, Children's Mercy HospitalFollow
Derek Marlor, Children's Mercy Kansas CityFollow
Rebecca M. Rentea, Children's Mercy Kansas CityFollow
Pablo Aguayo, Children's Mercy Kansas CityFollow
David Juang, Children's Mercy Kansas CityFollow
Richard J. Hendrickson, Children's Mercy Kansas CityFollow
Charles L. Snyder, Children's Mercy HospitalFollow
Shawn D. St.Peter, Children's Mercy Kansas CityFollow
Jason D. Fraser, Children's Mercy Kansas CityFollow
Tolulope A. Oyetunji, Children's Mercy Kansas CityFollow

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Description

Introduction: Initial management of hypertrophic pyloric stenosis (HPS) is correction of electrolyte disturbances with fluid resuscitation. In 2015, our institution implemented a fluid resuscitation protocol based on previous data that focused on minimizing blood draws and allowing immediate ad libitum feeds postoperatively. Here we describe the protocol and subsequent outcomes. Methods: We conducted a single-center retrospective review of patients diagnosed with HPS from 2016-2020. All patients were managed per the protocol outlined in Figure 1. All were given formula or breast milk after the post-anesthesia care unit and discharged home after tolerating three consecutive feeds. Feedings were given every 2-3 hours even if emesis occurred. Full feeds were defined as 60 ml of full-strength formula or breast milk every 2–3 hours ad lib. The primary outcome was the postoperative hospital length of stay (LOS). Secondary outcomes included the total number of preoperative labs drawn, time from arrival to the hospital to surgery, time from surgery to initiation of feeds, time from surgery to full feeds, and re-admission rate. Results: There were 271 patients included. The majority of the patients were male (83%, n=225) and Caucasian (77.5%, n=210). The median age and weight were 5 weeks (IQR 3.9,6.5) and 3.9 kg (IQR 3.4,4.4), respectively. None of the patients required a nasogastric tube or arterial blood gas sample. A total of 117 patients (43.2%) had electrolytic disturbances that required fluid boluses in addition to (1.5 x) maintenance fluids before surgical intervention. The median number of lab draws was 2 (IQR 1,2), with a median time from arrival to surgery of 19.2 hours (IQR 15.1,24.9). The median time from surgery to first feed and full feeds was 1.9 hours (IQR 1.2,2.7) and 11.4 hours (IQR 6.2,19.1), respectively. Patients had a median postoperative LOS of 22.2 hours (IQR 9.6,30.6). Re-admission rate within the first 30 postoperative days was 3.3% (9/271), with 2.2% (n=6) of re-admissions occurring within 72 hours of discharge. Indications for re-admission included stridor (1), decreased oral intake (1), and vomiting (7). One patient (0.4%) required re-operation due to incomplete pyloromyotomy. Conclusion: This protocol is a valuable tool for perioperative and postoperative management of all patients with HPS while minimizing uncomfortable interventions.

Publication Date

2-2023

Disciplines

Pediatrics | Surgery

When and Where Presented

Presented at the 18th Annual Academic Surgical Congress; Houston, TX; February 7-9th, 2023.

Recommended Citation

Cruz-Centeno, Nelimar; Fraser, James A. MD; Stewart, Shai MD; Marlor, Derek; Rentea, Rebecca M.; Aguayo, Pablo; Juang, David; Hendrickson, Richard J.; Snyder, Charles L.; St.Peter, Shawn D.; Fraser, Jason D.; and Oyetunji, Tolulope A., "Hypertrophic Pyloric Stenosis Protocol: A Single Center Study" (2023). Presentations. 78.
https://scholarlyexchange.childrensmercy.org/presentations/78